NSW Healthy Eating and Active Living Strategy:

Transcription

1 NSW Healthy Eating and Active Living Strategy: Preventing overweight and obesity in New South Wales

2 NSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) Fax. (02) TTY. (02) This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. NSW Ministry of Health 2013 SHPN: (CPH) ISBN: Further copies of this document can be downloaded from the NSW Health website

3 Foreword Prevention of disease and illness is about much more than just keeping people out of hospital it s about helping them enjoy the pleasures of healthy living. We are proud to have established the NSW Office of Preventive Health and the Ministerial Advisory Committee on Preventive Health. Each will ensure greater health outcomes for our community by better coordinating resources and ensuring linkages between the academic sector and the health system. The NSW Healthy Eating and Active Living Strategy: Preventing overweight and obesity in New South Wales is another important step in reducing the impact of lifestylerelated chronic disease in our state. The NSW Government is making a strategic, coordinated investment across agencies and sectors to change environments and support individuals to achieve and maintain a healthy weight, throughout life. In so doing, they will avoid preventable chronic diseases such as type 2 diabetes and cardiovascular disease. The Healthy Eating and Active Living Strategy aims to encourage the people of NSW to make healthy lifestyle choices and to be supported in their choices by health-focused planning, built environment and transport initiatives, as well as improved access to healthier foods and improved food labelling. We are providing more integrated transport and planning solutions to facilitate active living and improve health. We are delivering a range of evidence-informed healthy eating and physical activity programs for infants, children and young people, pregnant women, workers and older adults. We are now providing better consumer nutrition information to encourage healthier food and drink choices. And we are providing tailored healthy weight coaching to more people in NSW than ever before. We invite you to join with the NSW Government to make our great state the healthy state. Jillian Skinner MP Minister for Health Minister for Medical Research Kevin Humphries Minister for Healthy Lifestyles Minister for Mental Health Minister for Western New South Wales NSW Healthy Eating and Active Living Strategy NSW Health 1

4 Contents NSW Healthy Eating and Active Living Strategy at a glance 4 United for change A whole of government solution 7 Highlights The NSW Healthy Eating and Active Living Strategy 8 1. Current Status 11 Healthy eating and active living ages and stages 13 Reproductive years 13 Early years 15 Children and young people 16 Adults 18 Priority populations 20 Policy context 23 NSW 2021: A plan to make NSW number one 23 National Partnership Agreement on Preventive Health 24 National Partnership Agreement for Closing the Gap in Indigenous Health Outcomes and Aboriginal Health Plan Strategic Approach For Healthy Eating and Active Living 27 Environments to support healthy eating and active living 30 Strategic Direction 1 What we will do 31 State-wide healthy eating and active living support programs 34 Strategic Direction 2 What we will do 36 2 NSW Health NSW Healthy Eating and Active Living Strategy

5 Healthy eating and active living advice as part of routine service delivery 39 Strategic Direction 3 What we will do 40 Education and information to enable informed, healthy choices 43 Strategic Direction 4 What we will do Implementation, Monitoring and Evaluation 46 Guiding Principles 46 Workforce development 47 Research 47 Monitoring progress and outcomes Appendices 50 Appendix 4.1 Australian Dietary Guidelines 50 Appendix 4.2 Australian Physical Activity Recommendations 51 Appendix 4.3 Targets 52 Appendix 4.4 Existing NSW Government websites 53 Appendix 4.5 Obesity Senior Officers Group References 55 NSW Healthy Eating and Active Living Strategy NSW Health 3

6 NSW Healthy Eating and Active Living Strategy at a glance OUR GOAL To keep people healthy and out of hospital TARGETS Reduce overweight and obesity rates of children and young people (5-16 years) to 21% by 2015 Stabilise overweight and obesity rates in adults by 2015, and then reduce by 5% by 2020 Increase participation in sport, recreational, arts and cultural activities by 10% from 2010 levels in rural and regional NSW and in Sydney by 2016 More than double the mode share of bicycle trips made in the Greater Sydney region, at a local and district level by 2016 Increase the mode share of walking trips made in the Greater Sydney region at a local and district level to 25% by 2016 Increase the proportion of total journeys to work by public transport in the Sydney Metropolitan Region to 28% by 2016 Increase the percentage of the population living within 30 minutes by public transport of a city or major centre in metropolitan Sydney 4 NSW Health NSW Healthy Eating and Active Living Strategy

7 OBJECTIVES Reduce intake of energy-dense nutrient-poor food and drinks Increase consumption of fruit and vegetables Increase incidental, moderate and vigorous physical activity Reduce time spent in sedentary behaviours Increase community awareness of healthy eating and physical activity as protective factors against chronic disease Increase intake of water in preference to sugar-sweetened drinks This Strategy will encourage the community to make healthy lifestyle changes and support healthier living through better planning and transport solutions STRATEGIC DIRECTIONS 1. Environments to support healthy eating and active living 2. State-wide healthy eating and active living support programs 3. Healthy eating and active living advice as part of routine service delivery 4. Education and information to enable informed, healthy choices A+ NSW Healthy Eating and Active Living Strategy NSW Health 5

8 Being healthy doesn t need to be difficult or expensive it's about taking steps to integrate physical activity into our daily routines, and the choices we make about the foods we eat. It s time to shift our thinking and make healthier choices the norm. Geoff Huegill, Chair, Premier's Council for Active Living and Olympic swimmer 6 NSW Health NSW Healthy Eating and Active Living Strategy

9 United for change A whole of government solution The NSW Healthy Eating and Active Living Strategy: Preventing overweight and obesity in New South Wales provides a whole of government framework to promote and support healthy eating and active living in NSW. The problem Obesity is rapidly becoming the major health burden for NSW. Australia is experiencing unprecedented levels of overweight and obesity and NSW is no exception. In 2011, 52.6% of NSW adults (59.8% of males and 45.4% of females) were overweight or obese and in 2010, 22.8% of children (24% of boys and 21.5% of girls) were overweight or obese. Projections suggest that, should no action be taken to address the issue, 68% of adult males and 54% of adult females in NSW will be classified as overweight or obese by Healthy eating and active living are key factors in maintaining individual and population health. Optimum nutrition is essential for the healthy growth and development of infants and children. Healthy eating and physical activity promote health and wellbeing and prevent chronic disease across all life stages. Consuming more energy (kilojoules) than the body needs will lead to weight gain especially if combined with a low energy output (low activity level). Even a small excess energy intake over time can lead to weight gain resulting in overweight and obesity. Overweight and obesity increases the risk of developing chronic disease, including type 2 diabetes, hypertension, heart disease and some cancers. The prevention of chronic disease offers significant potential for societal gain, including benefits for individuals and families. People with poorer levels of health generally have lower rates of workforce participation, retire earlier and are less productive if at work. In 2008, the economic impact in NSW of obesity alone was estimated by Access Economics to be $19 billion, this includes $2.7 billion financial costs including productivity losses and $16.3 billion in costs of lost wellbeing. The solution The NSW Healthy Eating and Active Living Strategy provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease. The Strategy aims to encourage and support the community to make healthy lifestyle changes at a personal level, and create an environment that supports healthier living through better planning, built environments and transport solutions. The Strategy aims to ensure that everyone has opportunities to be healthy through the delivery of evidence-based, interactive and relevant programs. The NSW Healthy Eating and Active Living Strategy has four key strategic directions: Environments to support healthy eating and active living; State-wide healthy eating and active living support programs; Healthy eating and active living advice as part of routine service delivery; and Education and information to enable informed, healthy choices. The Strategy will assist the NSW Government to coordinate and manage the implementation of policies and programs across a range of government agencies and health services and to work in partnership with the academic and non-government sectors. NSW Healthy Eating and Active Living Strategy NSW Health 7

10 Highlights The NSW Healthy Eating and Active Living Strategy $79 million devoted to the enhancement of state-wide and targeted overweight and obesity programs aimed at infants, children and young people through the Healthy Children Initiative, including school-based programs $70 million for providing support to NSW workers that facilitates physical activity and healthy eating through the Healthy Workers Initiative Transport solutions that incorporate active transport into the design of the transport system A planning system for development and infrastructure that facilitates physical activity and healthy eating Expansion of the Get Healthy Information and Coaching Service to priority populations Support for those identified with pre-diabetes to halt progression to type 2 diabetes Support for women to achieve and maintain a healthy weight preconception and during pregnancy Consistent and easy to understand consumer nutrition information 8 NSW Health NSW Healthy Eating and Active Living Strategy

11 Through this Strategy, the NSW Ministry of Health will lead the effort to build a more active, healthy population in NSW. We will do this by enhancing initiatives that are already proving successful as well as delivering innovative policies, programs and services to support children and adults to eat well, be active and achieve and maintain a healthy weight. The problem cannot be solved by the health system alone and we will drive partnerships with key stakeholders to support healthy choices in the places where people live, work and play. Dr Kerry Chant, NSW Chief Health Officer and Deputy Director General, Population and Public Health NSW Healthy Eating and Active Living Strategy NSW Health 9

12 10 NSW Health NSW Healthy Eating and Active Living Strategy

13 1. Current status Physical activity and healthy eating are important factors in individual and community health and wellbeing, contributing to the prevention of many chronic diseases and enhancing an individual's quality of life. Healthy eating combined with a physically active lifestyle can help achieve and maintain a healthy weight. A healthy weight can be maintained by balancing the amount of energy consumed (food and drink) and the energy being used in daily activities and physical activity. Healthy eating Healthy eating is a critical behavioural risk factor that can have a significant impact on health at all ages. Optimum nutrition is essential for the healthy growth and development of infants and children. Healthy eating contributes to achieving and maintaining a healthy weight, and provides protection against chronic disease and premature mortality. The Australian Dietary Guidelines (Appendix 4.1) 1 provide evidence-based advice about the types and amounts of foods that are needed for health and wellbeing. The Guidelines encourage all Australians to eat a wide variety of nutritious foods from the five food groups while limiting foods and drinks high in saturated fat, added salt, added sugars and alcohol. Guidance on nutritious eating patterns, number of serves and appropriate portion sizes provides a sound approach to achieving and maintaining a healthy weight 2. Physical activity Being physically active is important for the healthy growth and development of infants, toddlers and pre-schoolers and for the health and wellbeing of children, young people and adults. Regular physical activity can help prevent a range of chronic diseases and their risk factors including heart disease, stroke, high blood pressure, type 2 diabetes and some cancers, and also help promote psychological wellbeing and healthy weight. Encouraging more active living provides social benefits such as an increased sense of community, social connectedness and engagement and reduces anxiety and depression 3, 4. The National Physical Activity Guidelines for Australians 5 (Appendix 4.2) outline the minimum levels of physical activity required to gain a health benefit and ways to incorporate incidental physical activity into everyday life for different age groups. Healthy eating means consuming the right types and quantities of food from the five food groups to ensure intake of all key nutrients while obtaining the right amount of energy (kilojoules) to achieve a healthy weight. NSW Healthy Eating and Active Living Strategy NSW Health 11

14 Conversely, unhealthy eating, in particular the over-consumption of energy-dense, nutrient-poor foods and drinks, physical inactivity and a sedentary lifestyle are predictors of overweight and obesity. Overweight and obesity is itself a serious, chronic medical condition. Approximately 40,000 NSW hospitalisations in were attributed to high body mass 7 and 16% of the difference in health between Aboriginal and non-aboriginal people is attributed to high body mass, second only to smoking as the major cause of the health disparity 8. Overweight and obesity is also associated with a wide range of conditions and illnesses, including type 2 diabetes, cardiovascular diseases and some cancers. Cardiovascular disease caused around 16,000 deaths in 2007 and in excess of 160,000 NSW hospitalisations in Diabetes caused approximately 4,500 deaths in 2007 and almost 6,600 hospitalisations in We need to recognise the interaction of individual, societal and environmental factors that impact directly and indirectly upon behaviours that have led to weight gain over the last fifteen years across NSW. Studies also indicate associations between oral health and obesity 10, 11, 12, diet 13, heart disease 14, diabetes 15 and stroke NSW Health NSW Healthy Eating and Active Living Strategy

15 Actions to influence healthy eating and physical activity require a comprehensive approach. This recognises the interaction of individual, societal and environmental factors that impact directly and indirectly upon behaviours that have led to weight gain over the last fifteen years across NSW. Healthy eating and active living ages and stages Reproductive years It is important that women are healthy in preconception and during pregnancy to minimise adverse outcomes for both the mother and child 17. The health of a child is influenced by the mother's health and nutritional status prior to and during pregnancy 18. Women in their reproductive years need to achieve and maintain healthy eating and an active lifestyle before pregnancy to minimise health risks to both themselves and their children 19. A healthy weight is also important preconception and healthy weight gain is critical during pregnancy. In NSW the prevalence estimates of overweight or obesity in 2011 for women in their reproductive years are 21.4% for year olds; 37.2% for year olds and 44.0% for year olds 20. Prevalence of overweight or obesity for women in their reproductive years % year olds overweight or obese 37.2% year olds overweight or obese 44.0% year olds overweight or obese Women in their reproductive years need to achieve and maintain healthy eating and an active lifestyle before pregnancy to minimise health risks to both themselves and their children. NSW Healthy Eating and Active Living Strategy NSW Health 13

16 Overweight and obesity is now the norm for Australians and with it has come an increasing burden from many diseases but especially diabetes, heart disease, arthritis and some cancers. To help overcome this we need a combined approach for the whole population and the individual. We need to redesign our society and communities so it is easier for individuals to make healthier choices and achieve a healthy weight and then we need to provide ways that help individuals lose their excess weight and get healthy again. Professor Ian Caterson, Foundation Director of the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, and Director of the Physical Activity Nutrition and Obesity Research Group at the University of Sydney 14 NSW Health NSW Healthy Eating and Active Living Strategy

17 Being overweight or obese during the reproductive years can result in reduced fertility with difficulty falling pregnant 21 and increased risks of complications in pregnancy including preeclampsia, thromboembolic disorders and gestational diabetes 22. Longer term complications of gestational diabetes can include increased risk of maternal type 2 diabetes and obesity in children 23. Health care providers are well placed to provide preconception advice to women about healthy eating 24, dietary supplements and maintaining a healthy weight 25. This will assist women to begin pregnancy in the best possible health 26. Early years Breastfeeding is very important for infant nutrition as it provides ideal food for the healthy growth and development of infants. Breastmilk contains all the nutritional requirements to support growth and development of infants to around 6 months of age. Breastfeeding provides a range of health benefits to infants including reduced risk of infection, asthma and atopic disease and sudden infant death syndrome. It contributes to improved cognitive development and protects against obesity, hypertension and some chronic diseases in later life. In addition, breastfeeding provides health benefits for mothers, including progress towards a healthy body weight and reduced risk of some cancers. Unsound infant feeding practices can result in nutrition and health problems that may have long-term effects on the child's development. There is a substantial body of evidence that indicates low rates of breastfeeding, particularly with regard to duration and exclusivity, put large numbers of infants and mothers at increased risk of overweight and obesity and ill health. In NSW in , while the proportion of children aged 0-23 months who were breastfed at birth was high (91.1%), this rate decreased for each month of age. The rate of breastfeeding at 6 months was 59.7%, and decreased to 32.3% at 12 months. By 12 months of age, consumption of a variety of nutritious foods from the food groups outlined in the Australian Guide to Healthy Eating is recommended. This helps toddlers to develop an acceptance of different foods and promotes attitudes and practices that can form the basis for lifelong healthy eating and drinking patterns. It is important to note that many infants and children depend on day care services for a large part of their nutrition. Early childhood education and care settings can support the healthy development of infants in their care by adopting the recommended infant feeding, healthy eating and physical activity recommendations. Proportion of children breastfed in NSW 28 To achieve optimal growth, development, and health, the Infant Feeding Guidelines: information for health workers 27 recommend infants should be exclusively breastfed until around 6 months of age when solid foods are introduced. Breastfeeding should be continued until 12 months of age and beyond while appropriate solid foods are introduced. Any breastfeeding is beneficial to the infant and mother. 91.1% breastfed at birth 59.7% breastfed at 6 months 32.3% breastfed at 12 months NSW Healthy Eating and Active Living Strategy NSW Health 15

18 Children and young people Healthy eating by children and young people is important in order to obtain adequate amounts of nutrients essential for good health, growth and development. Physical activity is also important to help achieve a healthy weight and associated health benefits. Childhood is a period where education about healthy eating and physical activity is key to establishing healthy practices in later years. Children and young people aged between 5 17 years vary considerably as to whether they meet the recommended levels of fruit and vegetable consumption and whether they undertake the recommended levels of physical activity. Primary school children are more likely than high school aged children to consume recommended amounts of fruit and vegetables*. High school children are more physically active than those in primary schools; but less likely than primary school aged children to meet recommendations regarding small screen time (e.g. television, computer games, internet) 29. Healthy eating and physical activity among NSW children aged 5 17 years 29 Adequate fruit consumption i Adequate vegetable consumption ii 95.9% 5-12 years 42.1% years 43.6% 5-12 years 20.1% years Adequate physical activity iii Meet small screen time recommendation iv 46.4% 5-10 years 63.5% years 46.3% 5-10 years 25.5% years * Based on 2003 Australian Dietary Guidelines i The 2013 Australian Guide to Healthy Eating recommends serves of fruit a day for 4 8 year olds, and 2 serves a day for 9-18 year olds ii The 2013 Australian Guide to Healthy Eating recommends that children aged 2 3 consume serves of vegetables a day, children aged 4 8 years consume serves of vegetables a day, children aged 9-11 years consume 5 serves of vegetables a day and adolescents aged years consume serves of vegetables a day iii National Physical Activity Guidelines recommend that children aged 5-18 years spend at least 60 minutes every day in moderate-to-vigorous physical activity iv National Physical Activity Guidelines recommend < 2hrs/day of screen time among children aged 5-18 years. 16 NSW Health NSW Healthy Eating and Active Living Strategy

19 Children who are overweight or obese have a much greater chance of going on to become overweight or obese adults. The prevalence of overweight or obesity among young people aged 5 to 17 years has stabilised in recent years, but is still at concerning levels, with more than one in five (22.8%) children (24% of boys and 21.5% of girls) being overweight or obese 30 (Figure 1). Figure 1: Prevalence of overweight or obesity in boys and girls, 5-17 years of age, NSW, PER CENT YEAR Boys overweight or obese Girls overweight or obese * Markers indicate SPANS data collection points in 1985, 1997, 2004, and 2010 NSW Healthy Eating and Active Living Strategy NSW Health 17

20 Adults Healthy eating in adults is about choosing a variety of the foods recommended in the Australian Dietary Guidelines, while limiting foods that are not essential for health and wellbeing. Engaging in moderate to vigorous physical activity provides a range of benefits to health and wellbeing and provides a key opportunity to increase daily energy expenditure to help balance the increase in energy intake and sedentary activity that has become typical of many lifestyles. Older adults benefit from healthy eating and being physically active as it assists with maintaining muscle strength and a healthy weight. Healthy eating and physical activity among NSW adults 31 Adequate fruit consumption i Adequate vegetable consumption ii 47.6% Male 56.4% Female 6.1% Male 11.1% Female Consume more than 6 cups of sweetened sugary drinks per week Consume takeaway foods more than once a week 34.6% Male 24.8% Female 34.0% Male 24.4% Female Adequate physical activity iii 59.6% Male 48.5% Female i The 2013 Australian Guide to Healthy Eating recommends that adults consume two serves of fruit daily ii The 2013 Australian Guide to Healthy Eating recommends adults consume 5 6 serves of vegetables daily iii Adequate physical activity is calculated from questions asked in the Active Australia Survey, and is defined as undertaking physical activity for a total of at least 150 minutes per week over 5 separate occasions. 18 NSW Health NSW Healthy Eating and Active Living Strategy

21 The prevalence of overweight or obesity among NSW adults has steadily increased since 1997 (Figure 2), such that in % of the adult population were classified as obese or overweight (59.8% of males and 45.4% of females) 32. Figure 2: Estimates of overweight or obesity, males and females, 16 years +, in NSW, PER CENT YEAR Males overweight or obese Females overweight or obese NSW Healthy Eating and Active Living Strategy NSW Health 19

22 Priority populations Within NSW there are sub-populations that warrant particular attention given their high prevalence of inadequate physical activity, unhealthy eating and higher than average rates of overweight and obesity. The NSW Government is committed to ensuring the needs of those most at risk of chronic disease are addressed by specific actions in this Strategy. These priority populations include but are not limited to the following: Aboriginal communities; Culturally and Linguistically Diverse communities; Regional and remote communities; and Socio-economically disadvantaged communities. Aboriginal communities In 2011, 54.1% of Aboriginal people reported undertaking adequate levels of physical activity, 51.8% of Aboriginal people consumed the recommended amounts of fruit, and 10.6% consumed the recommended amounts of vegetables 33. Food security is a further concern in Aboriginal communities. Food insecurity occurs when there is limited access to sufficient, safe and nutritious food and affects those with lower incomes disproportionately. In , 24% of Aboriginal people aged 15 years and over reported that they ran out of food in the last 12 months, compared to 5% of non-aboriginal people. These percentages are further increased for remote areas 34. In addition, overweight and obesity is more common in Aboriginal communities than the rest of the population. The proportion of Aboriginal people who are overweight and obese rose from an estimated 49.2% in 2002 to 62.3% in Combined with a shorter life expectancy, overweight and obesity contributes significantly to the burden of disease of Aboriginal people 36. Healthy eating and physical activity among NSW Aboriginal communities 33 This Strategy includes specific and targeted actions for Aboriginal people that are family and community-based and considers food security as a critical issue in nutrition programs in order to improve health outcomes in Aboriginal communities. 51.8% Consuming recommended amounts of fruit 54% Undertaking adequate levels of physical activity 10.6% Consuming recommended amounts of vegetables Overweight and obesity is more common in Aboriginal communities than the rest of the population. 20 NSW Health NSW Healthy Eating and Active Living Strategy

23 Improving the health of Aboriginal people in NSW means improving the physical, social and emotional wellbeing of individuals, families and communities. Aboriginal Community Controlled Health Services across NSW, and the Aboriginal Health and Medical Research Council of NSW, deliver and support culturally appropriate services and programs that encourage Aboriginal communities to make healthier food choices and lead more active lifestyles, as well as lending our skills and expertise to other parts of the health system through working in partnership. Sandra Bailey, CEO, Aboriginal Health and Medical Research Council of NSW NSW Healthy Eating and Active Living Strategy NSW Health 21

24 Culturally and linguistically diverse communities Significantly higher proportions of adults born in Lebanon (72.4%), Italy (70.6%) and Greece (64.8%) are overweight or obese, compared with the overall NSW adult population 37. Fruit and vegetable consumption differs among culturally and linguistically diverse communities in NSW. A significantly lower proportion of adults born in China (6.5%), Vietnam (5.6%), the Philippines (0.5%), Lebanon (1.7%), Italy (5.9%), Greece (5.4%) and Fiji (3.1%) consume adequate (5 or more) serves of vegetables a day, compared with the overall NSW adult population 38. A significantly lower proportion of adults born in China (49.3%), Vietnam (34.9%), Lebanon (36.8%), Italy (44.8%) and Greece (40.5%) undertake adequate levels of physical activity, compared with the overall NSW adult population 39. This Strategy includes a number of initiatives that support the delivery of programs and services that are appropriate for, and responsive to, NSW s diverse communities in order to address the high prevalence of risk factors that negatively affect the health of these populations. Significantly higher proportions of adults born in Lebanon (72.4%), Italy (70.6%) and Greece (64.8%) are overweight or obese, compared with the overall NSW adult population. Regional and remote communities Consumption of recommended daily serves of fruit and vegetables and undertaking adequate levels of physical activity does not differ substantially between people in major cities and regional and remote locations. However, adults who live outside of a major city have a greater prevalence of overweight and obesity than the state average. In 2011, 58.3% of those living in regional and remote locations were overweight or obese compared to the state average of 52.6% 40. This difference in prevalence is likely to be due to a range of factors. Initiatives within this Strategy will be tailored to meet the needs of people living in regional, rural and remote areas. Socio-economically disadvantaged communities In 2011 people who were most disadvantaged were less likely to undertake adequate levels of physical activity, with 48.1% of people in disadvantaged communities undertaking adequate physical activity compared to the state average of 53.9%. While only 8.0% met the recommendations regarding daily vegetable consumption, this did not differ significantly from the estimates for the state (8.7%). Less than half (48.7%) ate the recommended amounts of fruit, significantly lower than the estimates for the state (52.1%) 41. In 2010, the prevalence of combined overweight and obesity was higher among students from low socioeconomic status backgrounds (27.5%), compared with students from high socioeconomic status backgrounds (19.6%) 42. State-wide initiatives will be tailored and targeted to meet the needs of socio-economically disadvantaged communities to improve access to healthy food and assist them to eat healthily, be active and achieve and maintain a healthy weight. 22 NSW Health NSW Healthy Eating and Active Living Strategy

25 Policy context The NSW Healthy Eating and Active Living Strategy is informed by and complements four key policy and strategic initiatives: NSW 2021: A plan to make NSW number one; National Partnership Agreement on Preventive Health; National Partnership Agreement for Closing the Gap in Indigenous Health Outcomes; and Increase the mode share of walking trips made in the Greater Sydney region at a local and district level to 25% by 2016; Increase the proportion of total journeys to work by public transport in the Sydney Metropolitan Region to 28% by 2016; and Increase the percentage of the population living within 30 minutes by public transport of a city or major centre in metropolitan Sydney. NSW Government Aboriginal Health Plan (Appendix 4.3). NSW 2021: A plan to make NSW number one The NSW Government has developed a 10 year strategic plan which details the Government s commitment to improving opportunities and quality of life for the NSW population. Goal 11 recognises the need to keep people healthy and out of hospital. The NSW Healthy Eating and Active Living Strategy directly contributes to this goal and in particular provides actions to address the following commitments: Reduce overweight and obesity rates of children and young people (5-16 years) to 21% by 2015; and Stabilise overweight and obesity rates in adults by 2015, and then reduce by 5% by The Strategy also provides a range of actions that address the following targets of NSW 2021: A plan to make NSW number one: Increase participation in sport, recreational, arts and cultural activities in rural and regional NSW by 10% and in Sydney by 10% from 2010 to 2016; More than double the mode share of bicycle trips made in the Greater Sydney region, at a local and district level by 2016; NSW Healthy Eating and Active Living Strategy NSW Health 23

26 National Partnership Agreement on Preventive Health The NSW Government is a signatory to the National Partnership Agreement on Preventive Health which provides NSW with $150 million over seven years (to 2018), and commits NSW to achieving a number of specific targets including increasing: Fruit and vegetable consumption among children and adults; Physical activity among children and adults; and The proportion of the population which are at a healthy weight. The National Partnership Agreement on Preventive Health seeks to address the increasing prevalence of chronic disease through influencing healthy behaviours in workplaces, schools and the early childcare sector, and is supported by the implementation of national social marketing campaigns. National Partnership Agreement for Closing the Gap in Indigenous Health Outcomes and Aboriginal Health Plan The Council of Australian Government s commitment to closing the gap in life expectancy between Aboriginal and non-aboriginal people included investment by all Australian governments under the National Partnership Agreement for Closing the Gap in Indigenous Health Outcomes 43. The NSW Aboriginal Health Plan , developed with the Aboriginal Health and Medical Research Council of NSW, addresses common behavioural risk factors, such as high body mass and supports the NSW Government commitment to reduce rates of overweight and obesity. 24 NSW Health NSW Healthy Eating and Active Living Strategy

27 Creating a healthy future and a healthier population is a challenge that must be embraced by governments, industry, individuals and the community as a whole. That is why the Heart Foundation is committed to working with our partners in the industry, transport, food and the primary health care sector to deliver programs in schools, workplaces and the community that will inform and motivate us all to make healthier food and physical activity choices in our daily lives. These partnerships also help to shape the environments we live in and ensure our food production, food reformulation and agricultural policies are sustainable in a way that makes positive health choices easier for all members of the NSW community. Kerry Doyle, NSW Heart Foundation CEO NSW Healthy Eating and Active Living Strategy NSW Health 25

28 26 NSW Health NSW Healthy Eating and Active Living Strategy

29 2. Strategic Approach for Healthy Eating and Active Living There is widespread consensus that the rise in overweight and obesity is mostly a result of social, environmental and technological changes over the last few decades. These changes have led to environments which encourage excess energy intake and reduced energy expenditure. A successful whole-of-system approach to increasing healthy eating and physical activity requires action from all levels of government, industry, non-government organisations, individuals and communities and a range of strategies that target multiple population groups, at different stages of life. This Strategy deliberately focuses on prevention, recognising that there is much to be gained by the prevention of chronic diseases for the individual, the community and the health system 46. There is also growing evidence on the effectiveness and cost effectiveness of improving population health through prevention initiatives 47. Evidence shows that every kilogram of excess weight lost brings health benefits which can remain for a long time following weight loss. A weight loss of 5 10% significantly reduces an individual s risk of chronic disease 48, 49. There is evidence that increasing levels of physical activity irrespective of weight loss can improve health outcomes 50 and there is also emerging evidence that positive health behaviours (such as physical activity and healthy eating) reduce the risk of cardiovascular disease, regardless of Body Mass Index 51. Social, environmental and technological changes in society over the last few decades have led to an environment that promotes excessive energy intake while simultaneously decreasing opportunities and requirements for engaging in physical activity 45. Every kilogram of excess weight lost brings health benefits which can remain for a long time following weight loss. A weight loss of 5 10% significantly reduces an individual s risk of chronic disease. NSW Healthy Eating and Active Living Strategy NSW Health 27

30 The built environment where we live, work and play has a key role in supporting our physical and mental health. Our cities and towns must be places where it is easy for us to be active every day, as well as where we can easily access fresh and nutritious food whether it be in local shops or from nearby farms or community gardens. The only way that this can happen is if health and built environment professionals work together. The NSW Government s Healthy Eating and Active Living Strategy has many policies and actions that will create the conditions for this to happen to ensure that we have the best chance to deliver a healthy built environment for all members of our community. Associate Professor Susan Thompson, Fellow of the Planning Institute of Australia, Director, Healthy Built Environments Program, University of NSW 28 NSW Health NSW Healthy Eating and Active Living Strategy

31 The NSW Healthy Eating and Active Living Strategy addresses the many behavioural, socio-cultural and environmental factors that promote excess energy intake and discourage physical and incidental activity. The Strategy aims to create the conditions necessary for the initiation and maintenance of healthy eating and active living, at a personal and community and infrastructure level. It acknowledges that unhealthy eating, physical inactivity and unhealthy weight have complex causes and differential impacts among populations. Furthermore, the actions within this Strategy have been informed by evidence for effective interventions 52. This section outlines the actions to be undertaken by a range of NSW Government agencies from 2013 to Some actions are well established and known to the community, which build on the good work that is already taking place in NSW, while others are new investments based on emerging evidence and practice and these are marked NEW. Actions will be implemented in a manner that maximises reach to the population of NSW and focuses on specific populations where possible. Actions will be evaluated to contribute to the evidence base and the ongoing implementation of initiatives. NSW Healthy Eating and Active Living Strategy NSW Health 29

32 Environments to support healthy eating and active living Strategic Direction 1 Initiatives to create healthy food and healthy built environments are key components of a comprehensive approach to support healthy eating and active living. The food environment refers to what foods are available (via the local food supply and in food service and retail outlets), how much they cost, and how they are marketed. It affects the types and amount of foods consumed. Access to affordable, healthy food and limited access to energy-dense, nutrient-poor foods are prerequisites for healthy eating. Food marketing targeted to children generally promotes energy-dense, nutrient-poor foods and takes advantage of children's vulnerability to persuasive messages. There is widespread recognition of the negative impact this has on child obesity levels. Within this context, policy and environmental approaches that increase the availability of affordable healthy food choices are important 53,54. The built environment comprises physical design, patterns of land use, and the transport system; each influencing access to opportunities to be physically active for adults and children. Strategies in the built environment that are important for physical activity include those that: Facilitate and encourage walking, reduced traffic speed and volume; Promote access to recreation facilities; Incorporate mixed land use; Provide open and green space; Incorporate proximity to key destinations; and Increase density and diversity of housing. Perceptions of safety are also important. Active transport is of special interest as it is physical activity that can be built into everyday living. A built environment that provides easy, accessible connections between buildings, walkways, cycle paths and public transport nodes; and transport infrastructures that link residential, commercial, and business areas, is important to support active transport and physical activity 55,56. Strategic Direction 1 has a whole-of-population focus, however some actions have a specific emphasis on the following populations: Sydney metropolitan region; Aboriginal communities; People with a mental illness; and People with a disability. 30 NSW Health NSW Healthy Eating and Active Living Strategy

33 What we will do FOOD ENVIRONMENTS Availability and access to healthier choices ACTION NSW Food Authority and NSW Ministry of Health to improve availability and effectiveness of nutrition information: Continue to implement menu labelling legislation in fast food outlets and supermarkets Support menu labelling with community engagement campaigns Monitor industry compliance with menu labelling legislation Partners: Industry, Non-Government sector NSW Ministry of Health to identify additional evidence-based opportunities for NSW Government to develop policies and programs to enhance environments for healthy food (with a particular focus on kilojoules, fat and salt) NEW Partners: NSW Food Authority, Premier s Council for Active Living, Non-Government Organisations, Industry, Local Government NSW Ministry of Health and NSW Food Authority to contribute to national efforts to assist consumers in making healthier food choices: Improve front-of-pack labelling and support interpretation of label changes with targeted social marketing campaigns Reduce children and young people's exposure to the marketing and advertising of energy-dense and nutrient-poor foods Support food reformulation activities implemented under the National Food and Health Dialogue Partners: Premier s Council for Active Living, Non-Government Organisations, Industry NSW Department of Planning and Infrastructure to use land use/zoning to retain, and where possible increase, opportunities for agricultural and horticultural uses to keep fresh foods available locally Partners: Local Government, Department of Premier and Cabinet, Premier s Council for Active Living NSW Healthy Eating and Active Living Strategy NSW Health 31

34 ACTION NSW Ministry of Health and NSW Department of Education and Communities to improve the availability of healthy food in a range of settings: Introduce healthy food and catering policies in all government agencies and at the local level Deliver healthy menus in Sport and Recreation centres across NSW NEW Implement nutrition standards for patients in NSW mental health facilities and units NEW Implement the Nutrition in Schools Policy for healthy eating in school programs and activities With Local Councils, encourage a range of local food outlets to substitute cooking oils high in saturated fat with those that have a lower saturated fat content NEW Develop, implement and evaluate strategies to improve the availability of healthy foods in Aboriginal communities Partners: Other Government Agencies, Local Government, Official Visitors Program, Agency for Clinical Innovation, Premier s Council For Active Living, Local Health Districts and Networks, Industry, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services NSW Department of Trade and Investment, Regional Infrastructure and Services and NSW Ministry of Health to contribute to NSW initiatives on food security research, policy and programs to enhance opportunities for access to fresh and local foods, including among disadvantaged and remote communities NEW 32 NSW Health NSW Healthy Eating and Active Living Strategy

35 BUILT ENVIRONMENTS to support active living ACTION Transport for NSW to create public infrastructure for active travel through implementing government plans and strategies including: The NSW Long Term Transport Master Plan which will integrate transport to increase walking and cycling, with infrastructure, safety and behaviour change programs The NSW Walking Strategy to promote walking trips which will provide supports such as improved wayfinding and pedestrian amenity NEW The NSW Cycling Strategy which will encourage increased cycling trips by initiatives such as bike pathways NEW Partners: Department of Premier and Cabinet, Ministry of Health, Premier s Council for Active Living, Commission for Children and Young People, Department of Planning and Infrastructure, Local Government NSW Department of Planning and Infrastructure to plan and deliver healthy built environments in metropolitan, regional and rural areas through: Incorporating active living principles into infrastructure development and designing urban centres and housing to support physical activity and active transport Providing accessible and adaptable open spaces by supporting Local Government with guidelines on local open space planning Linking regional open spaces and preparing an inventory of regional open space in Sydney Partners: Transport for NSW, Local Government, Department of Premier and Cabinet, Ministry of Health, Local Health Districts, Premier s Council for Active Living, Commission for Children and Young People NSW Department of Education and Communities to increase use of community facilities in metropolitan, regional and rural areas to encourage moderate to vigorous physical activity through: Managing facility grant programs to increase the availability and quality of sport and recreation facilities Partners: Department of Planning and Infrastructure, Non-Government Organisations, Local Health Districts, Local Government NSW Healthy Eating and Active Living Strategy NSW Health 33

36 State-wide healthy eating and active living support programs Strategic Direction 2 Strategic Direction 2 aims to improve access to healthy eating and active living support programs. Appropriately targeted healthy eating and active living support programs across a person's lifecourse are essential for the prevention of obesity and chronic diseases. This approach starts at preconception, followed by maternal health and prenatal nutrition, infant nutrition, and child and adolescent health; reaches adults and older adults; and it encourages healthy eating and regular physical activity from youth into old age 57. Key settings 58 for implementing healthy eating and active living support programs include: Early childcare services: training of early childcare educators to promote and support healthy behaviours of young children; Schools: comprehensive whole-of-school programs involving parents and integrated into the school routine; Community sports: promoting healthy junior sports including healthy sporting canteens and building capacity of the industry to support participation growth; Programs listed within Strategic Direction 2 will be implemented within these key settings and take into account the potential population reach of the intervention. Whilst a range of private programs and services exist that promote healthy eating and physical activity, the NSW Government recognises that not everyone is able to access these programs. Strategic Direction 2 has a whole-of-population focus, however some actions have a specific emphasis on the following populations: Children and young people, pregnant women, adults and older people; Aboriginal communities; Disadvantaged socio-economic communities; Regional and remote communities; People from culturally and linguistically diverse backgrounds; and People at risk of type 2 diabetes. Workplaces: worksite interventions promoting organisational, cultural and environmental change, health risk assessments at work, and incentives to take part in physical activity and nutrition programs; and The community: community physical activity programs involving behavioural techniques and peer support for older adults; telephone support for individualised behaviour change for all adults and targeted to those most at risk. 34 NSW Health NSW Healthy Eating and Active Living Strategy

37 Munch and Move enables educators to provide children with the fundamentals for developing better eating habits, improving their gross motor skills and their handeye coordination as well as promoting balance and spatial awareness. The children are eager to be involved in the program including at meal times and during active play, dancing, music & movement and obstacle courses. All our families have been very supportive throughout the program as well as community members who volunteer their time to discuss or demonstrate healthier lifestyles for our children and their families. Maggie Bazouni, Centre Manager, First Grammar, Merrylands NSW Healthy Eating and Active Living Strategy NSW Health 35

38 What we will do Healthy eating and active living support programs ACTION NSW Office of Preventive Health and NSW Department of Education and Communities to deliver state-wide programs in early childhood, primary and high school and community settings, including: The Healthy Beginnings telephone-based support service to promote healthy eating and physical activity to parents of children 0-2 years NEW Healthy Habits telephone-based support service to promote healthy eating to parents of children 3-5 years NEW The Children s Healthy Eating and Physical Activity Program in: - Supported Playgroups NEW - Early Childhood (preschool, long day care and family day care) - Primary and Secondary Schools - Sporting and Recreational Clubs NEW The Premier s Sporting Challenge, which aims to have more students, more active, more of the time, and grants to assist participation in sports among those most in need The NSW Knockout Health Challenge which aims to support Aboriginal community members to eat healthy, be physically active and achieve and sustain a healthy weight Partners: Department of Premier and Cabinet, Ministry of Health, NSW Kids and Families, Local Health Districts, Non-Government Organisations, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services NSW Office of Preventive Health to deliver and evaluate the NSW Get Healthy Information and Coaching Service, which provides tailored health coaching for adults with healthy weight, nutrition and/or physical activity risk factors for chronic disease and enhance the service to provide tailored support for: Aboriginal people Culturally and linguistically diverse people NEW Pregnant women NEW Those at high risk of type 2 diabetes NEW Partners: Ministry of Health, Multicultural Health Communication Service, Non-Government Organisations, Agency for Clinical Innovation, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services, Medicare Locals 36 NSW Health NSW Healthy Eating and Active Living Strategy

39 ACTION WorkCover NSW, NSW Ministry of Health and NSW Office of Preventive Health to deliver and evaluate the NSW Healthy Workers Initiative to improve the health-related lifestyles of working adults through: Providing information and support to workplace management to make sustained organisational, policy and environmental changes to improve worker health with a particular emphasis on nutrition and physical activity NEW Establishing a confidential service to coordinate health risk assessment (including risk factors for type 2 diabetes), brief intervention and referral to diabetes prevention programs services and the Get Healthy Information and Coaching Service NEW Partners: Local Health Districts, Medicare Locals, Non-Government Organisations, Industry NSW Ministry of Health to develop, implement and evaluate healthy workforce programs in public sector agencies with a focus on physical activity, healthy eating and active travel including: Healthy workforce policies on improving the health and wellbeing of public sector employees The NSW Healthy Workers Initiative Promote incidental use of stairs in workplaces Partners: Public Service Commission, Premier s Council for Active Living, All NSW Government agencies, NSW Office of Preventive Health NSW Ministry of Health and Local Health Districts to deliver and evaluate and support referral to a range of physical activity programs for older people including: Community-based moderate exercise and walking programs Stepping On, which provides older adults with the strength and balance needed for healthy ageing and other relevant programs, e.g. tai chi Partners: Non-Government Organisations NSW Healthy Eating and Active Living Strategy NSW Health 37

40 ACTION NSW Department of Education and Communities to strengthen participation in sport and physical activity in metropolitan, regional and rural areas through: Grants which invest in participation in physical activity of those groups most in need of support Working in partnership with national and state sporting organisations, local government and others to support the development of participation strategies, particularly for underrepresented groups NEW Produce information resources that support the sport industry to grow participation Deliver sport education, professional development and networking opportunities that build industry capacity to grow participation Partners: Non-Government Organisations, Local Government, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services 38 NSW Health NSW Healthy Eating and Active Living Strategy

41 Healthy eating and active living advice as part of routine service delivery Strategic Direction 3 Integrating healthy eating and active living interventions into routine service delivery can increase population reach, is an efficient use of resources 59, 60 and is a key strategic direction for the NSW Healthy Eating and Active Living Strategy. Evidence suggests that enhanced service delivery to incorporate healthy eating and physical activity education, screening and brief interventions by primary health care providers and other agencies can result in improved health outcomes and identification of those at risk 61, 62. Actions in this Strategic Direction include a mix of primary, secondary and tertiary prevention and are evidence-based. The integration of healthy eating and active living interventions into the routine services delivered by NSW Health and other organisations has considerable potential for influencing individuals behaviours. This includes services delivered across a person's life, from maternal and infant health and into childhood, adulthood and older age. Strategic Direction 3 has a whole-of-population focus, however some actions have a specific emphasis on the following populations: Aboriginal people; Infants and children; and Older adults. NSW Healthy Eating and Active Living Strategy NSW Health 39

42 What we will do Integrate healthy eating and active living advice as part of routine service delivery ACTION NSW Kids and Families, NSW Ministry of Health, Local Health Districts and Non-Government Organisations to promote initiation and duration of breastfeeding as a way to provide good infant nutrition and reduce the risk of overweight and obesity in childhood, adolescence and early adulthood, including: Implementation of the NSW Ministry of Health Policy Directive PD2011_042 Breastfeeding in NSW: Promotion, Protection and Support Promoting breastfeeding in public policy A specific focus on addressing the special needs of groups at risk of low breastfeeding rates, particularly Aboriginal women Partners: Medicare Locals, Local Government, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services NSW Kids and Families, Local Health Districts and Agency for Clinical Innovation to incorporate healthy eating and physical activity into existing services and programs including: Sustaining NSW Families health home visiting program The Healthy Kids Check national screening program for children at four years of age The Aboriginal Maternal and Infant Health program and Building Strong Foundations for Aboriginal Children, Families and Communities Strategy Universal early childhood health services from birth to four years, including health promotion and screening strategies and use of the Personal Health Record (Blue Book) to monitor children s weight from birth and Body Mass Index from two years of age The NSW Chronic Disease Management Program (Connecting Care in the Community) Partners: Ministry of Health, Office of Preventive Health, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services Local Health Districts and Local Government to implement evidence-based sustained health promotion projects with significant population reach at the local level, consistent with the NSW Healthy Eating and Active Living Strategy Partners: Ministry of Health, Office of Preventive Health, Non-Government Organisations, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services 40 NSW Health NSW Healthy Eating and Active Living Strategy

43 ACTION Local Health Districts, Agency for Clinical Innovation and NSW Office of Preventive Health to develop, deliver and evaluate coordinated and comprehensive nutrition, overweight and obesity services, including: Nutrition and weight assessment in NSW health services with referral to appropriate community-based services Targeted Healthy Eating and Physical Activity Program for families with a child aged 7-13 who is overweight or obese Multidisciplinary obesity clinics in line with the NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults and the NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents Bariatric surgical services in line with the NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults and the NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents Partners: Non-Government Organisations, Medicare Locals, Private sector providers, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services NSW Ministry of Health, NSW Office of Preventive Health and Local Health Districts to identify and encourage the development of best practice and integrated diabetes prevention programs for at risk populations in metropolitan, regional and rural areas linked to the Healthy Workers Initiative NEW Partners: Medicare Locals NSW Obesity Senior Officers Group to investigate and leverage additional opportunities within NSW Government agencies, programs and services to provide evidence-based and relevant services and programs to the community to promote healthy eating and active living in metropolitan, regional and rural areas and disadvantaged populations NSW Ministry of Health and NSW Office for Preventive Health to investigate and leverage additional opportunities within NSW Government agencies, programs and services to provide evidence-based and relevant services and programs to promote healthy eating and active living in Aboriginal communities Partners: Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services, Local Health Districts, Agency for Clinical Innovation NSW Healthy Eating and Active Living Strategy NSW Health 41

44 Obesity in adults, adolescents and children can be a severe, chronic, relapsing disease. And thus effective treatment services need to be provided for those who are affected by the problem. This includes multidisciplinary clinics where patients and families can be supported to make long-term behavioural changes in diet, physical activity, sleep and sedentary behaviours all crucial to long-term healthy weight control. It also involves coordinated treatment of a range of obesity-associated health complications. And for some people, it will also mean the provision of bariatric surgery to aid with the management of more severe obesity. Coordinated services at primary, secondary and tertiary care level are all needed to help those who are affected by obesity. Professor Louise Baur, Discipline of Paediatrics and Child Health, University of Sydney, and Head, Weight Management Services, The Children s Hospital at Westmead 42 NSW Health NSW Healthy Eating and Active Living Strategy

45 A+ Education and information to enable informed, healthy choices Strategic Direction 4 The provision of education and information regarding the importance of healthy eating, physical activity and healthy weight throughout a person's life and to priority populations is an important component of the NSW Healthy Eating and Active Living Strategy. This recognises that Governments have a key role in the provision of accurate information to the general population regarding healthy eating and physical activity to support informed choices 63. Strategic Direction 4 has a whole-of-population focus, however some actions have a specific emphasis on the following populations: School aged children; Aboriginal people; Young people; and Low socio-economic groups. Public education campaigns are a key strategy used to influence individuals and society as they: raise awareness of the health risks associated with physical inactivity, unhealthy eating and obesity; and influence social norms, public opinion and public policy. Campaigns can be effective at changing knowledge, attitudes and beliefs (the priming steps of behaviour change) and can directly and indirectly affect behaviours 64, 65. Appropriately developed and implemented public education campaigns can also be used effectively to promote services, programs and environmental actions 66. NSW Healthy Eating and Active Living Strategy NSW Health 43

46 What we will do Education and information to enable informed, healthy choices ACTION NSW Department of Education and Communities to continue to deliver nutrition and physical activity education to primary and high school children and develop resources and training to support teaching and learning Partners: Ministry of Health, Office of Preventive Health, Local Health Districts NSW Department of Education and Communities to advocate for comprehensive inclusion of nutrition and physical activity content in the Australian Curriculum: Health and Physical Education Partners: Ministry of Health, Office of Preventive Health, Local Health Districts NSW Department of Education and Communities and NSW Office of Preventive Health to continue to implement the Live Life School program to increase the support for quality physical activity and healthy eating education in NSW primary schools Partners: Catholic Education Commission of NSW, Association of Independent Schools of NSW, Ministry of Health, Office of Preventive Health NSW Ministry of Health to develop an evidence-based, integrated cross-government community education and social marketing strategy to support regulation, programs and services including: Developing consistent nutrition, physical activity and prevention of overweight and obesity messages NEW Communicating these messages through a range of integrated NSW Government communication activities and channels Increasing the use of social media and new technologies to support healthy behaviours, particularly for young people NEW Adopting the Australian Dietary Guidelines in all nutrition initiatives and programs Adopting the National Physical Activity Recommendations in all physical activity initiatives Partners: Department of Education and Communities, NSW Food Authority, Local Health Districts, Non-Government Organisations, Premier s Council for Active Living, Multicultural Health Communications Service, Cancer Institute NSW, NSW Kids and Families, Aboriginal Health and Medical Research Council of NSW, Aboriginal Community Controlled Health Services, Office of Preventive Health 44 NSW Health NSW Healthy Eating and Active Living Strategy

47 NSW Healthy Eating and Active Living Strategy NSW Health 45

48 3. Implementation, monitoring and evaluation Guiding Principles Implementation of the NSW Healthy Eating and Active Living Strategy will be guided by the following principles: A POPULATION APPROACH Delivering sustained, effective and comprehensive initiatives that promote and support healthy eating and active living for all REDUCING INEQUITY Addressing the differences in health status in the community by recognising and responding to the needs of those groups whose health is poorest, and who are most likely to miss out on opportunities to be healthy, especially Aboriginal people MINIMISING HARM Recognising that intervention can produce harms as well as benefits, and working to minimise the harms WORKING IN PARTNERSHIP Recognising that addressing the many factors which influence overweight and obesity requires a multi-sectoral approach and development of strategic partnerships across government, industry, business, the non-government sector and research groups TRANSPARENCY Communicating openly and involving communities in strategy development and implementation BUILDING CAPACITY Building individual skills, strengthening community action and empowering organisations to create healthy environments and encourage healthy behaviours EFFECTIVE IMPLEMENTATION Providing strong infrastructure to support implementation and ensuring that progress in achieving targets is monitored 46 NSW Health NSW Healthy Eating and Active Living Strategy

49 Workforce development Building and maintaining an appropriately skilled workforce is critical to achieving the objectives of this Strategy. The workforce that implements this Strategy is diverse, with different agencies implementing initiatives in a range of settings. The workforce will be supported through the provision of a variety of education and training programs. Ongoing training and professional development will be provided to deliver high quality, evidence-based initiatives that support healthy eating, healthy weight and active living initiatives across a range of settings. Community organisations, the health promotion workforce, clinicians and the teaching and childcare workforce play a crucial role in maintaining and improving the health of the NSW population through education, advocacy, creating environments which support effective and responsive programs and enabling access to prevention and treatment services. Developing and strengthening the Aboriginal health workforce in the health system is an important component of providing culturally appropriate and competent health services to Aboriginal communities and encourage more Aboriginal people to work in health. Through the NSW Aboriginal Health Plan , the NSW Government will develop and sustain more Aboriginal people to work in health. A sustained workforce development effort is required to promote high levels of knowledge, ensure that skills and practices are effective and efficient, evolve with the evidence and respond to the needs of the diverse communities of NSW. Research Reliable evidence is fundamental to the success of overweight and obesity prevention efforts. It is critical that all stakeholders are kept up to date on trends, what works and what does not in influencing behaviours related to healthy eating and active living. The NSW Government will continue to invest in policy relevant, high quality and ethical research to improve and inform approaches to healthy eating, physical activity and the prevention of overweight and obesity. This will include intervention research to inform the development and implementation of new programs and services and evaluate their impact, and improve existing programs and service design in order to improve population health outcomes and reduce health inequities in NSW. The NSW Ministry of Health will continue to fund The University of Sydney's Physical Activity Nutrition and Obesity Research Group to support the NSW Government to advance the promotion of physical activity, healthy eating and overweight and obesity prevention consistent with NSW 2021: A plan to make NSW number one. The research centre will be required to provide information, contribute to strategy development, generate evidence and assist in workforce development in order to support the implementation of this Strategy. This continued investment in building the evidence base will improve access for decision-makers to high quality and contemporary information about physical activity, nutrition and weight status in NSW, relevant to state-wide and local priorities. It will also identify priorities for further research and contribute to applied research (including implementation trials and evaluation projects) that build the evidence base to inform better practice in the promotion of physical activity and nutrition and prevention of overweight, obesity and chronic disease in NSW. NSW Healthy Eating and Active Living Strategy NSW Health 47

50 Monitoring progress and outcomes The NSW Obesity Senior Officers Group (see Appendix 4.3) will oversee the implementation of the NSW Healthy Eating and Active Living Strategy, including the development of detailed implementation plans, monitoring outcomes and reporting. The NSW Obesity Senior Officers Group will develop a framework to identify the appropriate mechanisms to monitor and evaluate this Strategy. This will include established targets in NSW 2021: A plan to make NSW number one and the National Partnership Agreement on Preventive Health and will also identify priorities for service and program evaluation. Monitoring progress and outcomes for those initiatives that target Aboriginal communities will be developed based on the Partnership Agreement for Closing the Gap in Indigenous Health Outcomes and the Aboriginal Health Plan Progress towards these targets will be monitored by agencies responsible for individual programs and services, and at a NSW level through the NSW Population Health Survey, the NSW Child Health Survey and the NSW Schools Physical Activity and Nutrition Survey. Reports of program implementation will be made by responsible agencies and achievement of population-level targets will be reported through the NSW 2021 Plan. A mid-term review of progress will be undertaken in 2016, with an evaluation of the NSW Healthy Eating and Active Living Strategy undertaken in NSW Health NSW Healthy Eating and Active Living Strategy

51 On the way to work I heard a Get Healthy advert on the radio. I had been struggling with my weight for some time. I immediately called from my car s hands free and enrolled myself. That day I received a phone call, was sent a kit and started my successful journey to get healthy. The most imperative part was the waist measurement tape, which indicated that I fell into a high risk category for chronic diseases like hypertension. I lost 17½ kilograms with the help of Get Healthy. I am now eating healthily, exercising regularly and enjoying life with a new found energy. I am setting a positive example for our 2 year old. Parminder Singh, Get Healthy Service participant NSW Healthy Eating and Active Living Strategy NSW Health 49

52 4. Appendices Appendix 4.1 Australian Dietary Guidelines Guideline 1 To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly. Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight. Guideline 2 Enjoy a wide variety of nutritious foods from these five groups every day Plenty of vegetables, including different types and colours, and legumes/beans Fruit Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years) And drink plenty of water. Guideline 3 Limit intake of foods containing saturated fat, added salt, added sugars and alcohol a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savoury snacks. Replace high fat foods which contain predominantly saturated fats such as butter, cream, cooking margarine, coconut and palm oil with foods which contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/pastes and avocado. Low fat diets are not suitable for children under the age of 2 years. b. Limit intake of foods and drinks containing added salt. Read labels to choose lower sodium options among similar foods. Do not add salt to foods in cooking or at the table. c. Limit intake of foods and drinks containing added sugars such as confectionary, sugarsweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks. d. If you choose to drink alcohol, limit intake. For women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option. Guideline 4 Encourage and support breastfeeding Guideline 5 Care for your food; prepare and store it safely 50 NSW Health NSW Healthy Eating and Active Living Strategy

53 Appendix 4.2 Australian Physical Activity Recommendations Physical Activity Recommendations for Children 0-5 years For infants (birth to one year) physical activity particularly supervised floor-based play in safe environments should be encouraged from birth Toddlers (1 to 3 years) & Pre-schoolers (3 to 5 years) should be physically active every day for at least three hours, spread throughout the day Children younger than 2 years of age should not spend any time watching television or using other electronic media (DVDs, computer and other electronic games) and for children 2 to 5 years of age these activities should be limited to less than one hour per day Infants, toddlers and pre-schoolers should not be sedentary, restrained, or kept inactive, for more than one hour at a time, with the exception of sleeping. Physical Activity Recommendations for 5-12 year olds A combination of moderate and vigorous activities for at least 60 minutes a day is recommended. Physical Activity Recommendations for year olds At least 60 minutes of physical activity every day is recommended. This can be built up throughout the day with a variety of activities. Physical activity should be done at moderate to vigorous intensity. Physical Activity Guidelines for Adults Think of movement as an opportunity, not an inconvenience Be active every day in as many ways as you can Put together at least 30 minutes of moderate-intensity physical activity on most, preferably all, days. If you can, also enjoy some regular, vigorous activity for extra health and fitness Physical Activity Recommendations for Older Australians Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities. Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility. Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days. Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the recommended amount, type and frequency of activity. Older people who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to. NSW Healthy Eating and Active Living Strategy NSW Health 51

54 Appendix 4.3 Targets NSW 2021: A plan to make NSW number one Reduce overweight and obesity rates of children and young people (5-16 years) to 21% by 2015; Stabilise overweight and obesity rates in adults by 2015, and then reduce by 5% by 2020; Increase participation in sport, recreational, arts and cultural activities in rural and regional NSW by 10% and in Sydney by 10% from 2010 to 2016; More than double the mode share of bicycle trips made in the Greater Sydney region, at a local and district level by 2016; Increase the mode share of walking trips made in the Greater Sydney region at a local and district level to 25% by 2016; Increase the proportion of total journeys to work by public transport in the Sydney Metropolitan Region to 28% by 2016; and Increase the percentage of the population living within 30 minutes by public transport of a city or major centre in metropolitan Sydney. National Partnership Agreement on Preventive Health Healthy Children Initiative Increase in the proportion of children at unhealthy weight held at less than 5% from baseline for each State by 2016; proportion of children at unhealthy weight returned to baseline level by 2018; Increase in the mean number of daily serves of fruit and vegetables consumed by children by at least 0.2 for fruits and vegetables from baseline for each State by 2016; and 0.6 for fruits and 1.5 for vegetables by 2018; and Increase in the number of children participating in at least 60 minutes of moderate physical activity each day of 5% from baseline by 2016 and 15% from baseline by Healthy Workers Initiative Increase in proportion of adults at unhealthy weight held at less than 5% from baseline for each state by 2016; proportion of adults at healthy weight returned to baseline level by 2018; Increase in mean number of daily serves of fruits and vegetables consumed by adults by at least 0.2 for fruits and 0.5 for vegetables from baseline for each state by 2016; 0.6 for fruits and 1.5 for vegetables from baseline by 2018; and Increase in proportion of adults participating in at least 30 minutes of moderate physical activity on five or more days of the week of 5% from baseline for each state by 2016; 15% from baseline by NSW Health NSW Healthy Eating and Active Living Strategy

55 Appendix 4.4 Existing NSW Government Websites Websites and social media The Raising Children s Network website as a key channel for parents to receive healthy weight information (Commonwealth Government initiative) The Healthy Kids website as a channel supporting shared child and adult engagement with healthy weight The 8700 kilojoule campaign to raise knowledge of energy content of quick service food and drink and Premier s Council for Active Living The child-oriented resources on the NSW Healthy Kids website The youth-oriented resources on the website of the NSW Commission for Children and Young People "Stay Strong and Healthy it s worth it facebook page Go4Fun facebook page NSW Knockout Health Challenge facebook page AP 4.4 The NSW Get Healthy Information and Coaching Service The NSW Healthy Workers Initiative Resource portal of the linking physical and mental health initiative Promote local physical activity programs which focus on strength and balance through the Active and Healthy website Provide nutrition resources relevant to older people through the Active and Healthy website Sports Directory for Schools Gateway to Sport the online directory for entry level participation in sports NSW Healthy Eating and Active Living Strategy NSW Health 53

56 Appendix 4.5 Obesity Senior Officers Group The following NSW Government agencies are represented on the NSW Obesity Senior Officers Group, which is responsible for coordinating and monitoring the delivery of the NSW Healthy Eating and Active Living Strategy. NSW Ministry of Health Chief Health Officer and Deputy Director-General, Population and Public Health (Chair) Director, Centre for Population Health Manager, Strategic and Regulatory Policy, Centre for Population Health NSW Kids and Families Senior Clinical Advisor, Child and Family Health NSW Office of Preventive Health Director Department of Premier and Cabinet Associate Director, Health and Justice Branch Manager, Innovation and Development Group, Division of Local Government Public Service Commission Associate Director, Performance & Development NSW Department of Education and Communities Director, Early Childhood Education and Care Manager Policy, Commission for Children and Young People Manager, Industry Programs, NSW Sport and Recreation Division Representative, Public Schools NSW Transport for NSW Planning and Programs Manager, Planning and Programs Division Cancer Institute NSW Manager, Cancer Prevention Department of Planning Director, Development and Demographic Analysis NSW Food Authority Chief Scientist 54 NSW Health NSW Healthy Eating and Active Living Strategy

57 5. References 1, 2. National Health and Medical Research Council 2013, Australian Dietary Guidelines. Canberra: National Health and Medical Research Council. Retrieved from: guidelines/n55_australian_dietary_guidelines.pdf 3. Armstrong K, Edwards H 2004, The effectiveness of a pram walking exercise program in reducing depressive symptomology for postnatal women. International Journal of Nursing Practice;10(4): Jorm AF, Christensen H, Griffiths KM et al 2004, Effectiveness of complementary and self-help treatments for anxiety disorders. Medical Journal of Australia;181(7 Suppl): S29-S46 5. Australian Department of Health and Ageing 2004, National Physical Activity Guidelines for Australians. Retrieved from: health-pubhlth-strateg-phys-act-guidelines 6. Access Economics 2008, The growing cost of obesity in 2008: three years on. Retrieved from: com.au/pagefiles/7830/fullreportgrowingcostofobesi ty2008.pdf 7. Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Retrieved from: 8. Vos T, Barker B, Begg S, Stanley L, Lopez AD 2009, Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap. International Journal of Epidemiology;38: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Available at: Östberg AL, Nyholm M, Gullberg B, Råstam L, Lindblad U 2009, Tooth loss and obesity in a defined Swedish population. Scandinavian Journal of Public Health;37: Forslund HB, Lindroos AK, Blomkvist K et al 2002, Number of teeth, body mass index, and dental anxiety in middle-aged Swedish women. Acta Odontologica Scandinavia;60: Östberg AL, Bengtsson C, Lissner L, Hakeberg M 2012, Oral health and obesity indicators. BMC Oral Health;12(50) 13. Nowjack-Raymer RE, Sheiham A 2003, Association of edentulism and diet and nutrition in US adults. Journal of Dental Research;82(2): Katz J, Marc H, Porter S, Ruskin J 1998, Inflammation, periodontitis, and coronary heart disease. The Lancet;358(9297) 15. Thorstensson H, Hugoson A 1993, Periodontal disease experience in adult long-duration insulin-dependent diabetics. Journal of Clinical Periodontology;20: Joshipura KJ, Hung HC, Rimm EB et al 2003, Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke;34: Hillemeier MM, Downs DS, Feinberg ME et al 2009, Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study. Women's health issues: official publication of the Jacobs Institute of Women's Health;18(6)Suppl S United Nations Population Information Network 1994, Guidelines on Reproductive Health. Retrieved from: www. un.org/popin/unfpa/taskforce/guide/iatfreph.gdl.html 19. Gardiner PM, Nelson L, Shellhaas CS et al 2008, The clinical content of preconception care: nutrition and dietary supplements. American Journal of Obstetrics & Gynecology;199(6 Suppl 2):S Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Retrieved from: Dieticians Association of Australia, Australia s healthy weight week Fact sheet: Preparing for Pregnancy: Weight Matters. Retrieved from: uploads/2012/12/11.-prepare-for-a-baby_bm.pdf 22. Shaikh H, Robinson S, Teoh TG 2010, Management of maternal obesity prior to and during pregnancy [Review]. Seminars in Fetal & Neonatal Medicine;15(2): Rowlands I, Graves N, de Jersey S, McIntyre HD, Callaway L 2009, Obesity in pregnancy: outcomes and economics. Seminars in Fetal & Neonatal Medicine;15(2010): Melzer K, Schutz Y 2010, Pre-pregnancy and pregnancy predictors of obesity [Review]. International Journal of Obesity;34(Supp 2):S Van Dyke, Eileen M, MPS, PA-C 2008, Preconception care: ensuring healthier pregnancies. Journal of the American Academy of Physician Assistants;21(9): Siega-Riz AM, Deierlein A, Stuebe A 2010, Implementation of the New Institute of Medicine Gestational Weight Gain Guidelines. Journal of Midwifery & Women s Health;55(6): National Health and Medical Research Council 2012, Infant Feeding Guidelines Information For Health Workers. Retrieved from: files/the_guidelines/n56_infant_feeding_guidelines.pdf 28. Centre for Epidemiology and Research 2010, Report on Child Health from the New South Wales Population Health Survey Retrieved from: www0.health.nsw.gov.au/ resources/publichealth/surveys/hsc_0708.pdf NSW Healthy Eating and Active Living Strategy NSW Health 55

58 29, 30. Hardy LL, King L, Espinel P, Cosgrove C, Bauman A 2010, NSW Schools Physical Activity and Nutrition Survey (SPANS) 2010: Full Report. Sydney: NSW Ministry of Health 31. NSW Ministry of Health 2010, New South Wales Adult Health Survey. Sydney: NSW Ministry of Health. Retrieved from: www0.health.nsw.gov.au/ PublicHealth/surveys/hsa/10pub/ r_sdrink/r_sdrink_barresp.asp and Centre for Epidemiology and Evidence, Health Statistics New South Wales. Sydney: NSW Ministry of Health. Retrieved from: nsw.gov.au 32, 33. Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health. Retrieved from: Browne J, Laurence S, Thorpe S 2009, Acting on food insecurity in urban Aboriginal and Torres Strait Islander communities policy and practice interventions to improve local access and supply of nutritious food. Retrieved from: 35, 36. Centre for Epidemiology and Evidence 2012, The health of Aboriginal people of NSW: Report of the Chief Health Officer. 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60 SHPN: (CPH)